Prevention and control of Noncommunicable diseases

Challenges & Opportunities

Hai-Rim Shin MD., Ph.D. Team Leader NCD and Health Promotion

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Mongolia

Countries and Areas of the WHO Western Pacific Region

Republic of Korea Japan

China

Lao People's Democratic Republic Cambodia

Hong Kong SAR Macao SAR Viet Nam Philippines

Northern Mariana Islands Guam Marshall Islands

Malaysia Singapore Brunei Darussalam

Palau

Federated States of Micronesia Nauru Papua New Guinea Solomon Islands Kiribati

Australia

Tuvalu Tokelau Samoa Wallis & Futuna American Samoa Niue Vanuatu Fiji Cook Islands Tonga New Caledonia

French Polynesia

Pitcairn Islands

New Zealand

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO Regional Office for the Western Pacific 2009. All rights reserved.

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Changing times

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Outlines (Structure)

What can be done? What works?

Causes of causes

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Outlines (Structure)

What can be done? What works?

Causes of causes

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Causation pathway for NCD

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4 Diseases, 4 Modifiable Causative Risk Factors

Tobacco Use Cardiovascular Diabetes Unhealthy diets Physical Inactivity Harmful Use of Alcohol

Noncommunicable Diseases

Cancer

Chronic Respiratory

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Premature deaths due to NCD

Total number of deaths in the world
25 million
2.3M

Source:

6.8 M
20 million
2.3M

15 million

10.2M

3.7M
13.6M

10 million
0.5M

5.9M
0.6M

3.3M 3.0M 0.9M 1.1M

3.3 M
3.0M

High-income countries

Upper middle-income

Lower middle-income

Low-income countries

Group III - Injuries Low-income countries Group II Other deaths from noncommunicable diseases Group II Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I Communicable diseases, maternal, perinatal and nutritional conditions
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Mortality by WHO Region, 2000

% 75
Source: WHO, World Health Report 2001

50

25

AFR

EMR

SEAR
NCD

WPR

AMR
Injuries

EUR
CD+MCH+NUT

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Junk food generation

Average amount of typical snacks, fast food and treats eaten by children between the ages 410 in just one year.

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Rapid transition

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Think big, act on your tummy

INDIVIDUAL APPROACH

Longer the belt, shorter the life .

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Distribution of Waist Circumference

India, Female
35 30 25
POPULATION APPROACH

Percentage

20 15 10 5 0
< 50 50 - 59.9 60 - 69.9 70 - 79.9 80 - 89.9 90 - 90.9 100 - 109.9 110 - 119.9

Urban Peri-urban Rural

HIGH RISK INDIVIDUA L APPROAC H

WAIST CIRCUMFERENCE (cm)

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> 120

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Outlines (Structure)

What can be done? What works?

Causes of causes

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How can people make a choice?

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Hidden fats..

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Ban Transfats (USA)

With the stroke of a pen, Governor Arnold Schwarzenegger will make California the first state in the nation to make its restaurant foods free of artificial trans fat.
Its a bold move that will prevent thousands of heart attack deaths in that state and save millions of health care dollars.
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Governor Schwarzenegger Promotes Health and Nutrition by Signing NationLeading Trans Fat Bill July 25 2008
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Food Labelling systems in Australia: The more green and the fewer red symbols, the healthier the product.
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Traffic light labels - UK

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Marketing
They work on our desire

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WHO Recommendations
1. The policy aim should be to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt.
Effectiveness depends on two elements
Reach, frequency and impact (exposure) Content design and execution (power)

2. Overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in .
Depending on national circumstances and resources

Highest impact

Comprehensive approach-restricting all marketing to children Stepwise approach-either exposure or power

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Controls on advertisement
EU television without frontiers
directive TV adverts shall not cause moral or physical detriments to minors

Ireland

bans cartoon characters and celebrities to promote foods France mandatory health messages should accompany adverts on TV and radio Sweden total ban for adverts aimed at children less than 12 yrs
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It is cheaper to live unhealthy!!

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Taxation as a means to change behaviour

The tobacco experience
education is not enough: regulation, litigation, and legislation are needed too. Increasing taxes on cigarettes has been the single most effective strategy in reducing smoking.

The best chance for success is to impose a penny per ounce Sugar Sweetened Beverages tax, resulting in a rise of a dollar or two in the price of a six pack of sodas or a 2 litre bottle.
Most people favour such taxes. In New York state, projections a penny per ounce tax on SSBs: prevent 145 000 cases of adult obesity and 37 000 cases of diabetes in a decade. Save $2bn in healthcare costs.

Source: The case of the sugar sweetened beverage tax : Douglas Kamerow, BMJ 2010;341:c3719

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Change of bottles in life

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Physical inactivity
Work- mostly sitting At home in front of TV Play-on computer Travel-motorized Everything to make us more sedentary Obesogenic environment We need to change the environment which will facilitate physical activity
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Evidence

Trevor Shilton Saitama, Japan, July 2010

Why was the Toronto Charter for Physical Reports Activity Developed?

Commitment

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WHO Recommendations Global Physical Activity

5-17 years
Accumulate at least 60 minutes of moderate to vigorous intensity physical activity daily.

18-64 years
Do at least 150 minutes of moderate-intensity aerobic physical activity spread throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity spread throughout the week or an equivalent combination of moderate-and vigorous-intensity activity. Aerobic activity should be performed in bouts of at least 10 minutes.

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What determinesour health? What determines our health?

Source: Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute of Futures Studies, 1991; cited in Acheson D, 1998.

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Policy in action

Before:

After:

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Role of Ministries
Domain Food Industry M of Health M of Agriculture M of Food and Civil Supplies Work place Educational Institutes Hospitality Industry Community Level

M of Food Processing
M of Finance M of Industries M of Education M of Information and Broadcasting

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Upstream interventions
Policies/ Policies/ lack of in lack of it it in other other sectors sectors

Treating Treating individu individuals als with with NCD NCD

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Outlines (Structure)

What can be done? What works?

Causes of causes

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Enabling environment
Whole of Government approach

Health in all policies Strong policies and their implementation to control tobacco and alcohol Reduce market pressures from influencing dietary choices Control on advertisement of food to children Food labelling to help consumer choice Make local fruits and vegetables available and affordable Control fat, sugar and salt in mass manufactured products and restaurants Provide parks and cycle lanes to promote physical activity

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Settings based approach

Health promoting schools, workplaces, markets etc.

Healthy Cities/ Islands Multiple sectors working together

Captive population Usually under one command Facilitates policy level changes Can create enabling environment Availability of resources Ability to demonstrate results Sustainability of interventions Participation by beneficiaries
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What is health?

Health is wealth
American proverb

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Re-framing
Not: But: Health in All Policies

All policies need health!

Without health: we do not have an economically viable population; we cannot have sustainable communities we will not have the capacity to protect our environment
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Let us Move and Communicate

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Lets Move

Lets Move Kick-Off February 09, 2010 First Lady Michelle Obama kicks off Lets Move, a program designed to tackle childhood obesity by encouraging exercise and healthy eating. The First Lady is joined by Cabinet members, athletes, educators, students and others at the kickoff event.
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